Provider Demographics
NPI:1639805815
Name:BRADLEY, EMILY COLLEEN
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:COLLEEN
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 N FINE AVE STE 103A
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1558
Mailing Address - Country:US
Mailing Address - Phone:559-310-6544
Mailing Address - Fax:
Practice Address - Street 1:693 W BULLARD AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-1607
Practice Address - Country:US
Practice Address - Phone:559-455-0991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor